Rating Pain Relief

Q. How is the effectiveness of pain relievers measured? Is there a list that quantifies them by strength?

A. “It’s not like blood pressure, where a given dose reduces blood pressure a given amount,” said Dr. Neel D. Mehta, medical director of the Pain Medicine Center at NewYork-Presbyterian/Weill Cornell Medical Center. Instead, he said, “we must use an experience-based approach.”

The goal is always to find the lowest possible dose to treat pain aggressively while limiting interactions with other drugs and reducing the possibility of harmful side effects, Dr. Mehta said. Pain specialists measure effectiveness based on the patient’s own perception, he said, adding, “We believe our patients.”

Adults are asked to rate their pain on the familiar 1-to-10 scale: A chart of facial expressions is used for children. The doctor also considers how much the pain affects systems like sleeping and how much it interferes with physical functions like walking and standing.

Different kinds of pain require different kinds of relief. “First, there is nociceptive pain, like that of a broken bone or a surgical incision,” Dr. Mehta said. “Then there is neuropathic pain, resulting from disruption in the nervous system.” Opioids, though strong relievers of the first type of pain, “may not be as effective for neuropathic pain as, say, gabapentin,” a different kind of drug.